Treatment of classic-type Hirschsprung’s disease: rectoplasty with posterior triangular colonic flap versus transanal endorectal pull-through with rectoanal myotomy

Megumi Nakamura, Motoshi Wada, Taichi Fukuzawa, Hiromu Tanaka, Hironori Kudo, Ryo Ando, Satoshi Yamaki, Tomohiko Watanabe, Keisuke Tada, Yudai Nakajima, Masaki Nio

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Purpose: Our institution employs rectoplasty with a posterior triangular colonic flap (RPTCF) for classic-type Hirschsprung’s disease. Recently, we employed a modified Soave procedure: transanal endorectal pull-through with rectoanal myotomy (TEPTRAM). In both procedures, the internal sphincter muscle is completely divided vertically at the 6 o’clock position. Unlike RPTCF, TEPTRAM does not require abdominal manipulation. We aimed to verify the usefulness of TEPTRAM. Methods: 64 patients with classic-type Hirschsprung’s disease who underwent surgery between 1970 and 2017 were divided into group R (RPTCF, 47 cases) and group T (TEPTRAM, 17 cases). We compared the defecation function of the groups. Results: No patient showed fecal incontinence (R: 0/41, T: 0/10, ns). Three patients (6%) in group R and four (24%) in group T developed postoperative enterocolitis (P = 0.16). Three patients (10%) in group R and one (20%) in group T needed an enema (P = 0.36). Conclusion: There was no adverse effect of rectoanal myotomy; incontinence was not observed in either procedure. Although there was no significant difference, the incidences of enterocolitis and constipation were slightly higher in group T, perhaps because of the residual muscle cuff; therefore, it is necessary to provide best care with attention to constipation immediately after surgery.

Original languageEnglish
Pages (from-to)203-207
Number of pages5
JournalPediatric Surgery International
Volume35
Issue number2
DOIs
Publication statusPublished - 2019 Feb 5

Keywords

  • Duhamel procedure
  • Hirschsprung’s disease
  • Posterior triangular colonic flap
  • Rectoanal myotomy
  • Soave procedure
  • Transanal endorectal pull-through

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Surgery

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